6.3 Disorders of the Upper Gastrointestinal Tract

Question 1

Fundamental aetiology/pathogenesis of peptic ulcers

Answer 1

• imbalance between regenerative and damaging forces of the gastric mucosa
• Usually brought on by H pylori infection, or NSAIDs that impair COX-1 (which otherwise replenishes mucosa)
• Pepsin and acid are required for pathogenesis

Question 2

Clinical features of peptic ulcers

Answer 2

• Epigastric pain (burning/aching), 1-3 hours after meals
• Anaemia
• Nausea/vomiting/haematemesis
• Malaena
• Bloating

Question 3

Investigations for suspected stomach ulcers

Answer 3

• Iron studies/CBC (?anaemia)
• H Pylori Breath Test
• H Pylori antibody blood test
• Endoscopy and biopsy

Question 4

Treatment of stomach ulcers

Answer 4

• Treat H pylori
• Discontinue NSAIDs
• PPIs to reduce acid secretion

Question 5

GORD pathophysiology

Answer 5

• Reduced action of Lower Oesophageal Sphincter
• If acid overwhelms the defensive capabilities of the stratified, non-keratinised squamous oesophageal epithelium, damage results

Question 6

What are some foods that can contribute to GORD? Lifestyle factors?

Answer 6

Foods:
- Caffeine
- Chocolate
- Pepperminet
- Alcohol
- Citrus/tomato (Vit C)
Lifestyle:
- Weight gain
- Smoking
- Eating, then lying down

Question 7

GORD symptoms

Answer 7

• Heartburn (sub-sternal burning discomfort)
• Regurgitation (bitter, acidic flux when lying down/bending over)

Question 8

GORD treatments

Answer 8

• Antacids
• PPIs/histamine antagonists
• Lifestyle changes (weight loss, smaller meals, less acidic foods)

Question 9

Complications of GORD

Answer 9

• Stricture (narrowing 2° to attempted healing)
• Barrett’s oesophagus (metaplasia… uh oh)

Question 10

Pathogenesis of achalasia

Answer 10

• Failure of myenteric plexus
• Causes loss of relaxation of the lower oesophageal sphincter

(anti-GORD)

Question 11

Achalasia symptoms/signs

Answer 11

• Dysphagia
• Regurgitation
• Chest pain
• Cough
• Weight loss

Question 12

Achalasia Ix

Answer 12

• Manometry (measure muscle contraction)
• Barium swallow
• Endoscopy

Question 13

Achalasia management (2 surgical procedures w/ different mechs)

Answer 13

• Dilation
• Botox (why does this work?)

Question 14

List some causes of dysphagia

Answer 14

• Neurological: stroke, dementia, ALS
• Muscular issues
• Obstruction
• Oesophageal: achalasia, cancer, motility disorders
• GORD: scarring of LOS

Question 15

What type of cancer is oesophageal carcinoma? What can it arise from, and what are some risk factors?

Answer 15

• Squamous cell adenocarcinoma
• Can progress from Barrett’s oesophagus
• Obesity, alcohol, smoking all predispose

Question 16

Symptoms/signs of oesophageal carcinoma

Answer 16

• Dysphagia
• Weight loss
• May have iron deficiency anaemia/bleed 2° to haemoptysis

Question 17

Oesophageal carcinoma Ix of choice

Answer 17

Endoscopy

Question 18

Follow-up Ix/referrals for suspected oesophageal carcinoma

Answer 18

• CT for staging
• PET scan
• Histology
• Refer to MDT meeting

Question 19

Treatment for oesophageal carcinoma

Answer 19

• Stent (palliative)
• Chemoradiotherapy
• Surgical resection

Question 20

What are some risk factors for gastric carcinoma?

Answer 20

• Smoked/salted food (deli)
• Obesity, alcohol, smoking
• Helicobacter
• Pernicious anaemia
• Common in men, older

Question 21

What are some signs/symptoms of gastric carcinoma?

Answer 21

• Pain
• Vomiting
• Dysphagia
• Weight loss
• Anorexia
• Virchow’s node (indicates lymphatic involvement)

Question 22

Gastric carcinoma Ix

Answer 22

• Bloods
• Endoscopy
• Staging CT
• PET scans

Question 23

Gastric carcinoma treatment

Answer 23

• MDT
• Periperative chemotherapy
• Surgical resection (partial/total gastrectomy)